Provider Demographics
NPI:1689493918
Name:WINICKI, MARGARET ROSE
Entity type:Individual
Prefix:
First Name:MARGARET ROSE
Middle Name:
Last Name:WINICKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 SW US VETERANS HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6045
Mailing Address - Country:US
Mailing Address - Phone:503-535-9645
Mailing Address - Fax:
Practice Address - Street 1:3455 SW US VETERANS HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6045
Practice Address - Country:US
Practice Address - Phone:503-535-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202201068RN163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty